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General NPI Number Information
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NPI Number | 1083035042
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Entity Type | Individual
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Provider Name | HEATHER AZZALINA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 1337 BLUE VALLEY DR
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City | PEN ARGYL
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State | PA
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Zip | 18072-1815
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Country | US
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Telephone | 610-654-1200
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Fax | 610-654-1201
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Provider Business Mailing Address
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Address Line | PO BOX 1754
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City | ALLENTOWN
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State | PA
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Zip | 18105-1754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP013425
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License Number State | PA
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